Alcoholic Ketoacidosis: Warning Signs and Treatments

He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference. With timely and aggressive intervention, the prognosis for a patient with AKA is good. The long-term prognosis for the patient is influenced more strongly by recovery from alcoholism. Calcium oxalate crystals in the urine also suggests ethylene glycol poisoning.

Enhancing Healthcare Team Outcomes

Healthcare providers diagnose the condition using physical exams, blood tests, and other procedures. The outlook for acidosis depends on its severity and the underlying cause. While untreated or very severe forms of this condition can be fatal, if properly diagnosed, many people can effectively manage their condition.

Signs and symptoms of alcoholic ketoacidosis

These conditions have to be ruled out before a medical professional can diagnose you with alcoholic ketoacidosis. For patient education information, see the Mental Health and Behavior Center, as well as Alcoholism and Alcohol Intoxication. Elevated cortisol levels can increase fatty acid mobilization and ketogenesis.

Alcoholic ketoacidosis: clinical and laboratory presentation, pathophysiology and treatment

This biochemical process is responsible for the wasting and cachexia seen during starvation. DKA occurs more frequently with type 1 diabetes, although 10% to 30% of cases occur in patients with type 2 diabetes,[2] in situations of extreme physiologic stress or acute illness. According to the morbidity and mortality review of the CDC, diabetes itself is one of the most common chronic conditions in the world and affects an estimated 30 million people in the United States. Alcoholic ketoacidosis is a complication of alcohol use and starvation that causes excess acid in the bloodstream, resulting in vomiting and abdominal pain. Your doctor and other medical professionals will watch you for symptoms of withdrawal. Your doctor may also admit you to the intensive care unit (ICU) if you require ongoing care.

Resolution of ketoacidosis in children with new onset diabetes: Evaluation of various definitions

Alcoholic ketoacidosis[5] occurs in patients with chronic alcohol abuse and liver disease and usually develops following abrupt withdrawal of alcohol or an episode of acute intoxication. It is not uncommon for the ingested ethanol to have already been metabolized, leading to low or normal serum levels when checked. In normal alcohol metabolism, the ingested ethanol is oxidized to acetaldehyde and then to acetic acid with the enzyme alcohol dehydrogenase, during which process the coenzyme nicotinamide adenine dinucleotide (NAD+) is reduced to NADH. The acetic acid can be shunted towards ketogenesis in favorable insulin/glucagon concentrations, which is seen in hypoglycemia. In addition to this, the increased NADH further suppresses gluconeogenesis and reduces free glucose, perpetuating ketogenesis.[6] After abrupt withdrawal, rising catecholamine levels as a bodily response cause lipolysis and ketosis. The high ratio of NADH to NAD+ also favors the reduction of acetoacetate to beta-hydroxybutyrate.

• In 1940, Dillon et al1 described a series of nine patients who had episodes of severe ketoacidosis in the absence of diabetes mellitus, all of whom had evidence of prolonged excessive alcohol consumption.
• Magnesium and phosphate levels should be measured and repleted if the serum levels are found low.
• Patients can have a long-standing history of alcohol use and may also present following binges.
• The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation.
• You can prevent alcoholic ketoacidosis by limiting your alcohol intake.
• Glucose comes from the food you eat, and insulin is produced by the pancreas.

Alcohol dehydrogenase (ADH), a cytosolic enzyme, metabolizes alcohol to acetaldehyde in hepatocytes. Acetaldehyde is metabolized further to acetic acid by aldehyde dehydrogenase. Both steps require the reduction of nicotinamide adenine dinucleotide (NAD+) to reduced nicotinamide adenine dinucleotide (NADH). Intravenous benzodiazepines can be administered based on the risk of seizures from impending alcohol withdrawal. Antiemetics such as ondansetron or metoclopramide may also be given to control nausea and vomiting.

Diabetes self-management education (DSME) and diabetes self-management support (DSMS) are recommended at the time of diagnosis of prediabetes or diabetes and throughout the lifetime of the patient. DSMS is an individualized alcoholic ketoacidosis pathophysiology plan that provides opportunities for educational and motivational support for diabetes self-management. In AKA, transaminitis, and hyperbilirubinemia due to concurrent alcoholic hepatitis may also be present.

• If severe hypokalemia is present dextrose containing fluids can be held until potassium levels are normalized.
• This literature review discusses the history, characterisation, pathophysiology, diagnosis, and management of AKA.
• Most cases are reversible, but severe and untreated acidosis can become fatal.
• Excessive alcohol consumption often causes malnourishment (not enough nutrients for the body to function well).
• If they can’t use glucose because there’s not enough insulin, your body switches to another method to get energy — breaking down fat cells.

Treatment and Management of Acidosis

• They may have a rapid and deep respiratory effort as a compensatory mechanism, known as Kussmaul breathing.
• They attributed this to the administration of therapy (intravenous dextrose) rather than the withdrawal of the toxin, ethanol.
• Serum sodium is usually relatively low because of shifts of solvent (water) from the intracellular to extracellular spaces because of the osmotic pull of hyperglycemia.